Wrist Pain

Question 1

GANGLION

• what is it?
• commonly found where?
• more common in men or women?
• Tx?
• what allows them to be excised?

Answer 1

• cyst arising from joint or tendon sheath
• They are most commonly seen around the back of the wrist
• are 3 times more common in women
• Ganglions often disappear spontaneously after several months
• if they are troublesome

Question 2

DUPUYTREN’S CONTRACTURE

• what is it?
• which fingers are most commonly affected?
• typical patient?
• family history = +ve or -ve?
• causes?
• Tx?

Answer 2

Fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended.

The ring finger and little finger are the fingers most commonly affected.

in males over 40 years of age

+ve family history

manual labour
phenytoin treatment
alcoholic liver disease

surgical and involves fasciectomy.
high chance of recurrence

Question 3

TRIGGER FINGER

• what is it?
• Associations?
• Tx?
• who is surgery reserved for?

Answer 3

• abnormal flexion of the digits

-more common in women
rheumatoid arthritis
diabetes mellitus

steroid injection is successful in the majority of patients. A finger splint may be applied afterwards

patients who have not responded to steroid injections

Question 4

De Quervain’s tenosynovitis

• what is it?
• affects who?
• features?
• what special test can you do for diagnosis?

Mx?

Answer 4

tendons in anatomical snuffbox are inflammed making thumb hurt

• females aged 30-50
• pain on the radial side of the wrist
  tenderness over the radial styloid process
  abduction of the thumb against resistance is painful

Finkelstein’s test: with the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation

Mx:
analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective

Question 5

CARPAL TUNNEL SYNDROME

• compression of which nerve?
• features?
• Tinel’s sign?
• Phanel’s sign?
• diagnosis?
• Tx?

Answer 5

compression of median nerve in the carpal tunnel.

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night

Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms

Formal diagnosis is usually made by electrophysiological studies

Treatment

• corticosteroid injection
• wrist splints at night
• surgical decompression (flexor retinaculum divisi